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Intended and unintended consequences of the implementation of minimum unit pricing of alcohol in Scotland: a natural experiment

So, Vivian; Millard, Andrew D; Katikireddi, S Vittal; Forsyth, Ross; Allstaff, Sarah; Deluca, Paolo; Drummond, Colin; Ford, Allison; Eadie, Douglas; Fitzgerald, Niamh; Graham, Lesley; Hilton, Shona; Ludbrook, Anne; McCartney, Gerry; Molaodi, Oarabile; Open, Michele; Patterson, Chris; Perry, Samantha; Phillips, Thomas; Schembri, Gabriel; Stead, Martine; Wilson, Janet; Yap, Chris; Bond, Lyndal; Leyland, Alastair H


Vivian So

Andrew D Millard

S Vittal Katikireddi

Ross Forsyth

Sarah Allstaff

Paolo Deluca

Colin Drummond

Allison Ford

Douglas Eadie

Niamh Fitzgerald

Lesley Graham

Shona Hilton

Anne Ludbrook

Gerry McCartney

Oarabile Molaodi

Michele Open

Chris Patterson

Samantha Perry

Gabriel Schembri

Martine Stead

Janet Wilson

Chris Yap

Lyndal Bond

Alastair H Leyland


Scotland was the first country to implement minimum unit pricing for alcohol nationally. Minimum unit pricing aims to reduce alcohol-related harms and to narrow health inequalities. Minimum unit pricing sets a minimum retail price based on alcohol content, targeting products preferentially consumed by high-risk drinkers. This study comprised three components.

This study comprised three components assessing alcohol consumption and alcohol-related attendances in emergency departments, investigating potential unintended effects of minimum unit pricing on alcohol source and drug use, and exploring changes in public attitudes, experiences and norms towards minimum unit pricing and alcohol use.

We conducted a natural experiment study using repeated cross-sectional surveys comparing Scotland (intervention) and North England (control) areas. This involved comparing changes in Scotland following the introduction of minimum unit pricing with changes seen in the north of England over the same period. Difference-in-difference analyses compared intervention and control areas. Focus groups with young people and heavy drinkers, and interviews with professional stakeholders before and after minimum unit pricing implementation in Scotland allowed exploration of attitudes, experiences and behaviours, stakeholder perceptions and potential mechanisms of effect.

Four emergency departments in Scotland and North England (component 1), six sexual health clinics in Scotland and North England (component 2), and focus groups and interviews in Scotland (component 3).

Research nurses interviewed 23,455 adults in emergency departments, and 15,218 participants self-completed questionnaires in sexual health clinics. We interviewed 30 stakeholders and 105 individuals participated in focus groups.

Minimum unit pricing sets a minimum retail price based on alcohol content, targeting products preferentially consumed by high-risk drinkers.

The odds ratio for an alcohol-related emergency department attendance following minimum unit pricing was 1.14 (95% confidence interval 0.90 to 1.44; p = 0.272). In absolute terms, we estimated that minimum unit pricing was associated with 258 more alcohol-related emergency department visits (95% confidence interval –191 to 707) across Scotland than would have been the case had minimum unit pricing not been implemented. The odds ratio for illicit drug consumption following minimum unit pricing was 1.04 (95% confidence interval 0.88 to 1.24; p = 0.612). Concerns about harms, including crime and the use of other sources of alcohol, were generally not realised. Stakeholders and the public generally did not perceive price increases or changed consumption. A lack of understanding of the policy may have caused concerns about harms to dependent drinkers among participants from more deprived areas.

The short interval between policy announcement and implementation left limited time for pre-intervention data collection.

Within the emergency departments, there was no evidence of a beneficial impact of minimum unit pricing. Implementation appeared to have been successful and there was no evidence of substitution from alcohol consumption to other drugs. Drinkers and stakeholders largely reported not noticing any change in price or consumption. The lack of effect observed in these settings in the short term, and the problem-free implementation, suggests that the price per unit set (£0.50) was acceptable, but may be too low. Our evaluation, which itself contains multiple components, is part of a wider programme co-ordinated by Public Health Scotland and the results should be understood in this wider context.


So, V., Millard, A. D., Katikireddi, S. V., Forsyth, R., Allstaff, S., Deluca, P., …Leyland, A. H. (2021). Intended and unintended consequences of the implementation of minimum unit pricing of alcohol in Scotland: a natural experiment. Public Health Research, 9(11), 1-210.

Journal Article Type Article
Acceptance Date May 31, 2021
Publication Date 2021-10
Deposit Date Mar 16, 2022
Publicly Available Date Mar 16, 2022
Journal Public Health Research
Print ISSN 2050-4381
Electronic ISSN 2050-439X
Publisher NIHR Journals Library
Peer Reviewed Peer Reviewed
Volume 9
Issue 11
Pages 1-210
Public URL
Additional Information Free to read: This content has been made freely available to all.; Contractual start date: 9-2017; Editorial review begun: 10-2020; Accepted for publication: 5-2021


Published article (6.2 Mb)

Copyright Statement
Copyright © 2021 So et al. This work was produced by So et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaption in any medium and for any purpose provided that it is properly attributed. See: For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication
must be cited.

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